Peritoneovenous (LeVeen) Shunt

Abstract

Because of the unusual clinical course of a patient with hepatic cirrhosis, refractory ascites, and hepatorenal syndrome, we were able to examine the complex interrelationships between massive ascites, renin-aldosterone activity, and renal and hepatic function before and after placement of a peritoneojugular vein (LeVeen) shunt. Measurements indicated that when the shunt was functioning, renin-aldosterone production was suppressed, the hepatorenal syndrome was reversed, and ascites remitted. These data suggest that hyperreninemia, hyperaldosteronism, and functional renal abnormalities of this disorder are potentially reversible and arise primarily from the imbalance between formation and drainage of hepatosplanchnic lymph rather than from hepatocellular dysfunction, lowered plasma oncotic pressure, or portal hypertension.

Hepatorenal Syndrome: Recent Insights and Therapy

“…Similar results may be obtained by portocaval shunt ing in man with cirrhosis [37][38][39][40][41][42]. Based on all the observations above, it is tempting to suggest that the extreme prerenal pattern of the HRS is the consequence of the 'underfill ing' of the circulation in cirrhosis.…”

“…Over the last decade, the use of the peritoneo-jugular LeVeen shunt received much attention [37][38][39][40][41][42], The reduction in intra abdominal pressure combined with increased central blood volume caused by the shunt ('artificial thoracic duct') in some patients led to an improvement in their hemodynamic status, restoration of renal perfusion, GFR and increase in urine output and sodium excretion. However, the procedure is associ ated with relatively high risk and morbidity including infections, coagulopathies and var ious technical problems [70], At present, the LeVeen shunt cannot yet be regarded as an established terapy for HRS patients [70,71].…”

Nephritis Associated with an Infected Peritoneovenous LeVeen Shunt

“…The peritoneovenous LeVeen shunt (PVLS) is a device that has proved effective in treating refractory massive ascites (1)(2)(3). Bacterial infection is a main complication of the PVLS, occurring in 15-55% of the patients, and is responsible for 50% of the early deaths after its insertion (4)(5).…”